Impact of VEGF and VEGF receptor 1 (FLT1) expression on the prognosis of stage III esophageal cancer patients after radiochemotherapy.
OBJECTIVE
High expression of vascular endothelial growth factor (VEGF) is negatively associated with clinical outcome. The prognostic value of VEGF receptor 1 (FLT1) is unclear. This retrospective study investigated the impact of tumor expression of VEGF and FLT1 on outcome in 68 stage III esophageal cancer patients.


METHODS
The impact of tumor VEGF and FLT expression (< or =10% vs. > 10%) and five additional potential prognostic factors on overaLL survival (OS) and Locoregional control (LC) was retrospectively evaluated. These factors included T-stage (T3 vs. T4), N-stage (NO vs. N1), treatment (radiochemotherapy plus resection vs. radiochemotherapy alone), erythropoietin (ERYPO 10000, Janssen-Cilag, Neuss, Germany) administration during radiotherapy, and majority of hemoglobin levels during radiotherapy (<12 vs. > or =12 g/dl). Subgroup analyses were performed for patients receiving resection (R0 vs. R1/2 resection). The factors found to be significant on univariate analyses (Kaplan-Meier method, log-rank test) were included in multivariate analyses performed with the Cox proportional hazard model.


RESULTS
On univariate analysis, improved OS was associated with T3 stage (p = 0.011), surgery (p = 0.019), and hemoglobin > or =12 g/dl (p < 0.001). Improved LC was associated with T3 stage (p = 0.025), hemoglobin > or =12 g/dl (p < 0.001), and VEGF negativity (p = 0.045). On multivariate analyses, only hemoglobin maintained significance. In patients having surgery, RO resection was significantly better than R1/2 resection for OS (p < 0.001) and LC (p < 0.001).


CONCLUSIONS
Preradiotherapy tumor VEGF expression appears negatively correlated with outcomes, whereas FLT1 expression appears to have no significant impact on OS and LC.
Rades
Dirk
D
Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Germany. Rades.Dirk@gmx.net
Golke
Helmut
H
Schild
Steven E
SE
Kilic
Ergin
E
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004921:Erythropoietin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis*; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000032:analysis*
D042461:Vascular Endothelial Growth Factor A; D004921:Erythropoietin; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1